How to correctly submit “brand medically necessary” e-prescriptions
E-prescribing is a term that physicians will hear more and more as health care technology advances. As physicians dive into all of the benefits of their electronic health record technology, electronically prescribing medications for patients will most likely be one of the first programs put into use, as it is also part of the requirements of “meaningful use” for the EHR incentive program. Electronic prescribing may help physicians save time, money, and — most important — help eliminate medication confusion, according to the Vendor Drug Program.
To submit an electronic prescription to the Vendor Drug Program that meets CMS requirements for “brand medically necessary” dispensing, the following elements must be included in the electronic prescription transaction that is sent from the prescriber to the pharmacy.
- The physician must select the “Dispense as Written” (DAW) option on the electronic prescription pad. If the system defaults to “Substitution Allowed,” the prescriber must make sure this is checked prior to sending the prescription.
- “Brand Medically Necessary” must be included in the “Notes to Pharmacy.” This field is generally for free-form text and where the pharmacy receives additional information on SIG or other notes. Some systems may have this as a separate field to choose a reason why the prescription is DAW.
If an e-prescription is received by a pharmacy with DAW indicated but without the free-text message or additional note, the pharmacist must contact the prescriber for a new prescription. Once the pharmacy receives the e-prescription with both of these data elements, the pharmacy should submit the prescription claim with a DAW value of “1” and a Prescription Origin code value of “3.” The presence of “Brand Medically Necessary” in the free-text field (within the pharmacy’s system) will be subject to review by the Vendor Drug Program.
During VDP reviews, failure of the pharmacy to produce electronic records that indicate a DAW of 1 and “Brand Medically Necessary” in the free-text message for the e-prescription will make such prescriptions subject to recoupment. All non-electronic “Brand Medically Necessary” prescriptions must continue to comply with the current policies as outlined in the Vendor Drug Program Pharmacy Provider manual and applicable Texas State Board of Pharmacy rules.